Hypersensitivity pneumonitis secondary to gold therapy has been described in only a limited number of patients. The clinical presentation is variable and optimal therapy is not well established. Two patients presenting with life-threatening respiratory insufficiency that progressed despite discontinuation of gold therapy are described. Dramatic improvement occurred following corticosteroid administration. Review of previously reported cases shows corticosteroid therapy to be efficacious. Patients with gold hypersensitivity pneumonitis may have a fulminant course and many require corticosteroids for relief.